Provider Demographics
NPI:1407897705
Name:LAVELL, BEATRIZ ISABEL (MD)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:ISABEL
Last Name:LAVELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 EAST CAMPUS MALL
Mailing Address - Street 2:UNIVERSITY HEALTH SERVICES
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1381
Mailing Address - Country:US
Mailing Address - Phone:608-265-5600
Mailing Address - Fax:608-263-6884
Practice Address - Street 1:333 EAST CAMPUS MALL
Practice Address - Street 2:UNIVERSITY HEALTH SERVICES
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1381
Practice Address - Country:US
Practice Address - Phone:608-265-5600
Practice Address - Fax:608-263-6884
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI43104-020207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34126200Medicaid
WI60205OtherDEAN HEALTH INSURANCE
H47831Medicare UPIN
WI080195431Medicare PIN
WI60205OtherDEAN HEALTH INSURANCE
WI34126200Medicaid